Information About You

 
25% of survey complete.
Opt out of evaluation?

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* 1. Opt out of evaluation?

Is the youth active?

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* 2. Is the youth active?

Parent/Guardian INFORMATION

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* 3. Parent/Guardian INFORMATION

TEEN INFORMATION

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* 4. TEEN INFORMATION

Date of Birth

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* 5. Date of Birth

Date of Birth
Name of School

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* 10. Name of School

How did you find out about this Program

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* 12. How did you find out about this Program

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